What happens during a NIOSH HHE of an oncology clinic?

Personal protective equipment


• Wear a chemotherapy-protective gown, goggles, and double chemotherapy-protective gloves when preparing and administering chemotherapy drugs. 


• Gloves should be tested and certified for use when handling chemotherapy drugs by the American Society for Testing and Materials and labeled as chemotherapy gloves.¹⁴ Nonlatex chemotherapy protective gloves are preferred because of the risk for latex sensitivity. Gloves should be changed every 30 minutes or when torn, punctured, or contaminated. Wash your hands immediately after removing the gloves.


• Protective gowns should be disposable and made of polyethylene-coated polypropylene (nonlinting and nonabsorbent) or other laminate materials. Gowns should have a closed front, long sleeves, and elastic or knit closed cuffs. Dispose of gowns after each use. 


• Wear eye and face protection whenever there is the potential for chemotherapy drugs to splash in the face or eyes.

• If respirators are worn voluntarily, follow the OSHA respiratory protection standard [29 CFR 1910.134], and provide Appendix D of the standard.15 Store respirators properly and replace them when they become visibly clogged or difficult to breathe through.


After the final report has been issued, the HHE program routinely conducts a follow-up evaluation to learn how useful the findings of the HHE were to the workplace, if recommendations addressed workplace concerns, and to identify any challenges faced by the workplace when implementing recommendations. Through this process and in communications with the oncology clinic, we learned that many of the recommendations made as a result of this HHE were implemented. Changes included retraining all clinic employees on how to properly handle chemotherapy drugs, improving housekeeping practices, updating policies and procedures for hazardous drug exposures, and increasing use of personal protective equipment specifically made to be protective against chemotherapy drug exposures. Visit www.cdc.gov/niosh/hhe/followback/default.html for more information about the NIOSH HHE follow-up activities. 


CONCLUSION


Nurses or other oncology staff who have health and safety concerns about their workplace should alert their management and occupational health and safety representatives, if available. Resources for addressing occupational health and safety concerns are available through the NIOSH HHE program. An employee can request an HHE if he or she is currently employed at the workplace of concern. An HHE can also be requested by the employer or an officer of a labor union that represents employees at the facility. 


NIOSH will not reveal the names of the persons who made the request to the employer if they indicate this on the request form. The Occupational Safety and Health Act and the Federal Mine Safety and Health Act prohibit employers from retaliating or punishing employees for making HHE requests or cooperating with NIOSH investigators (see Section 11(c) of the Occupational Safety and Health [OSHA] Act or Section 105(c) of the Mine Safety and Health [MSHA] Act). The US Department of Labor is responsible for enforcing these antidiscrimination provisions. If discrimination is suspected, the employee should contact OSHA or MSHA office immediately. To request a HHE or for more information about the HHE program, visit www.cdc.gov/niosh/hhe/request.html. 


Health hazard evaluations are conducted to investigate possible workplace health hazards, according to a federal law. After requesting an HHE, the requestor may receive information or a referral to a more appropriate agency, or a site evaluation by a comprehensive team of experts may be performed. A report with specific recommendations and general guidelines for good occupational health practices is sent to the evaluated clinic. HHE reports are available on the CDC Web site. ONA 

Disclaimer: Mention of company or product names does not imply endorsement by the National Institute for Occupational Safety and Health.


James Couch is a certified industrial hygienist; he conducts occupational safety and health research for CDC/NIOSH. Christine West is a nurse epidemiologist and certified occupational health nurse specialist; she conducts occupational health research for CDC/NIOSH. Maureen Niemeier is a technical writer/editor.


REFERENCES


1. Black LA, Presson AC. Hazardous drugs. Occup Med. 1997;12(4):669-685.


2. Schreiber C, Radon K, Pethran A, et al. Uptake of antineoplastic agents in pharmacy personnel. Part II: study of work-related risk factors. Int Arch Occup Environ Health. 2003;76(1):11-16.


3. Valanis BG, Vollmer WM, Labuhn KT, Glass AG. Acute symptoms associated with antineoplastic drug handling among nurses. Cancer Nurs. 1993;16(4):288-295. 


4. Krstev S, Perunicić B, Vidaković A. Work practice and some adverse health effects in nurses handling antineoplastic drugs. Med Lav. 2003;94(5):432-439.


5. Peelen S, Roeleveld N, Heederik D, et al. Toxic effects on reproduction in hospital personnel [in Dutch]. Netherlands: Elsevier; 1999.


6. Valanis B, Vollmer WM, Steele P. Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists. J Occup Environ Med. 1999;41(8):632-638.


7. Ündeğer Ü, Başaran N, Kars A, Güç D. Assessment of DNA damage in nurses han¬dling antineoplastic drugs by the alkaline COMET assay. Mutat Res. 1999;439(2):277-285.


8. Skov T, Maarup B, Olsen J, et al. Leukaemia and reproductive outcome among nurses handling antineoplastic drugs. Br J Ind Med. 1992;49(12):855-861. 


9. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicalsto Humans. Lyon, France: International Agency for Research on Cancer; World Health Organization; 2004. http://monographs.iarc.fr/. Accessed: April 22, 2013.


10. NIOSH Alert: Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Cincinnati, OH: National Institute for Occupational Safety and Health; 2004. DHHS (NIOSH) Publication No. 2004-165.


11. Appendix A—Primary containment for biohazards: selection, installation and use of biological safety cabinets. In: Chosewood LC, Wilson DE, eds. Biosafety in Microbiological and Biomedical Laboratories. 3rd ed. US Government Printing; 1993. http://www.cdc.gov/biosafety/publications/bmbl5/BMBL5_appendixA.pdf. Accessed April 30, 2013. 


12. ASHP Guidelines on Handling Hazardous Drugs. Am J Health Syst Pharm. 2006;63(12):1172-1191.


13. (797) Pharmaceutical compounding—sterile preparations. In: United States Pharmacopoeia Commission. United States Pharmacopeia-National Formulary (USP26 NF21). Rockville, MD: United States Pharmacopeial; 2002.


14. ASTM D6978-05 Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs. West Conshohocken, PA: American Society for Testing and Materials International; 2005.


15. Code of Federal Regulations. Washington, DC: National Archives and Records Administration’s Office of the Federal Register; 2013.


From the June 01, 2013 Issue of Oncology Nurse Advisor